Implantable Cardioverter Defibrillators

Transcription

1 Implantable Cardioverter Defibrillators PHYSICIAN REIMBURSEMENT GUIDE EFFECTIVE JANUARY 1, 2014

2 Contents Page Introduction 03 Medicare Coding and Payment Overview 04 Physician Fee Schedule 04 Coverage for ICD Procedures 05 References 06

3 Introduction This guide provides hospital coding and payment information for implantable cardioverter defibrillator (ICD) procedures. In addition, St. Jude Medical offers a reimbursement hotline, which provides live coding and billing information from dedicated reimbursement specialists. Hotline support is available from 8:00 a.m. to 5:00 p.m. Central Time, Monday through Friday at (855) This document and the information contained herein is for general information purposes only and is not intended and does not constitute legal, reimbursement, coding, business or other advice. Furthermore, it is not intended to increase or maximize payment by any payer. Nothing in this document should be construed as a guarantee by St. Jude Medical regarding levels of reimbursement, payment or charge, or that reimbursement or other payment will be received. Similarly, nothing in this document should be viewed as instructions for selecting any particular code. The ultimate responsibility for coding and obtaining payment/reimbursement remains with the customer. This includes the responsibility for accuracy and veracity of all coding and claims submitted to third party payers. Also note that the information presented herein represents only one of many potential scenarios, based on the assumptions, variables and data presented. In addition, the customer should note that laws, regulations and coverage and coding policies are complex and are updated frequently, and therefore the customer should check with its local carriers or intermediaries often and should consult with legal counsel or a financial, coding or reimbursement specialist for any coding, reimbursement or billing questions or any related issues.

4 Medicare Coding and Payment Overview Physician Fee Schedule Effective Dates: January 1, 2014 December 31, 2014 CPT Code Description Facility wrvus ICD System Implant Insertion or replacement of ICD system; single or dual chamber $ ICD Generator Insertion of ICD generator with existing single lead $ Insertion of ICD generator with existing dual leads $ With existing multiple leads $ Lead(s) Insertion of a single lead $ Insertion of two leads $ Insertion of LV lead, with attachment to previously placed pacemaker or ICD generator (including revision of pocket, removal, insertion and/or replacement of existing generator) Insertion of LV lead at time of insertion of pacemaker or ICD generator (including upgrade to dual chamber system and pocket revision) $ $ Repositioning/Repair/Revision Repositioning of previously implanted transvenous pacemaker or ICD lead (right atrial or right ventricular) Repositioning of previously implanted LV lead (including removal, insertion and/or replacement of existing generator) $ $ Repair of single lead $ Repair of two leads $ Revision or relocation of skin pocket for ICD $ Removal with Replacement Removal of ICD generator with replacement of ICD generator; single lead system $ Dual lead system $ Multiple lead system $ Removal only Removal of ICD generator, without replacement $ Removal of single or dual ICD leads; by transvenous extraction $ Electrophysiologic Evaluation EP Evaluation of single or dual chamber ICD leads including threshold evaluation at time of initial implant or replacement $ With testing of single or dual chamber ICD $ Subsequent or periodic analysis (follow-up) $

5 Coverage for ICD Procedures Medicare National Coverage Determination (NCD) Medicare has National Coverage Determinations for Implantable Cardiac Defibrillators. The following resources relate to Medicare Coverage for Cardiac Rhythm Disease Management (CRDM) products and procedures. Below are the links to the Medicare National Coverage Determinations for CRDM therapies. Implantable Cardiac Defibrillators National Coverage Determination (NCD) for Implantable Automatic Defibrillators CMS Publication 100-3, Manual, 20.4 Medicare NCD for Cardiac Resynchronization Therapy Defibrillators (CRT-Ds) At this time there is no specific NCD for CRT-Ds. However, some MACs have developed Local Coverage Determinations (LCDs) for CRT-D that apply to certain regions. Providers are advised to check with their local MAC or non-medicare payer(s) to determine patient coverage and coding/billing guidelines.

6 References CMS Update: Medicare Coverage Database: St. Jude Medical Inc. Global Headquarters One St. Jude Medical Drive St. Paul, Minnesota USA Fax St. Jude Medical S.C., Inc. U.S. Division 6300 Bee Cave Road Bldg. Two, Suite 100 Austin, TX USA Fax SJMprofessional.com Please check the applicable user s manual for the FDA approved indications for use. Current Procedural Terminology (CPT) 2013 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Unless otherwise noted, indicates that the name is a trademark of, or licensed to, St. Jude Medical or one of its subsidiaries. ST. JUDE MEDICAL and the nine-squares symbol are trademarks and service marks of St. Jude Medical, Inc. and its related companies St. Jude Medical, Inc. All Rights Reserved. US A EN (03/14)